Abstract

Out-of-hospital cardiac arrest (OOHCA) is a common public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with OOHCA by emergency medical services (EMS), or among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post-cardiac arrest care. Effective hospital-based interventions for OOHCA exist but are used infrequently. Increased volume of patients or procedures of individual providers and hospitals is associated with better outcomes for several other clinical disorders. Regional systems of cardiac resuscitation include a process for identification of patients with OOHCA, standard field and hospital care protocols for patients with OOHCA, monitoring of care processes and outcome, and periodic review and feedback of these quality improvement data to identify problems and implement solutions. Similar systems have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. Many more people could survive OOHCA if regional systems of cardiac resuscitation were implemented and maintained. The time has come to do so wherever feasible.

Abstract

There have been recent proposals to enhance organization and funding of emergency care in the U.S. because of perceived deficiencies – especially in services for children. Motor vehicle crashes are among the leading causes of death and disability for both adults and children in the United States and place a heavy burden on emergency and trauma care. This study uses the Fatality Accident Reporting System (FARS) to examine the length of time between vehicle crash and hospital arrival for crashes involving seriously injured children transported to hospital in 2003. Only about 1/3 (1868) of 5436 crashes had data for hospital arrival time. For those cases that could be evaluated, median transport time was 46 minutes (52 minutes for rural crashes, 35 minutes for those in urban areas). There was substantial delay in a minority of crashes. Delays occurred both between crash and emergency services (EMS) notification and between EMS contact and hospital arrival and were more common in rural crashes. Other research has shown that prolonged transport times are associated with worsened trauma outcomes. Since states vary in the extent and sophistication of their trauma services we sought, but failed to find, correlation between number of trauma centers (Level I and II or all-level) per million population and median arrival time calculated for each U.S. state. Integrated trauma care begins at the site of injury and continues through post-hospital care. Time between injury and hospital admission is one important indicator of trauma system performance.